Systemic Steroid Properties

Note:

• MedCalc Steroid Equivalence Calculator
• Medrol Dosepak (Tapering 6 day course) = 24, 20, 16, 12, 8, 4 mg of methylprednisolone daily = 30, 25, 20, 15, 10, 5 mg of prednisone or prednisolone daily
• “Immunosuppressive doses” defined as:
  • ≥20 mg prednisone QD [or equivalent] for >14 days (US CDC)
  • ≥40 mg prednisolone QD [or equivalent] for >7 days (UK Green Book)
  • Immunosuppression persists for at least 1 mo after treatment discontinuation

Topical Steroids

Inhaled Steroids

Steroid Adverse Effects

Topical Steroids (Schneider)

• Steroid side effects are rare and reversible
  • Reversible: telangiectasia, atrophy, acne, rosacea, increased hair growth
  • Non-reversible: striae
  • Low-mid potency steroids will not cause clinically significant adrenal suppression

Steroid Drug Interactions

Adrenal Suppression Screening

Steroid Hypersensitivity

• IgE-mediated reactions may be due to additives:
  • Triamcinolone – carboxymethylcellulose
  • Hydrocortisone – parabens
  • Methylprednisolone – polyethylene glycol
    • Case report that some concentrations of IV methylprednisolone (Pfizer Solu-medrol) and tablets contain cow's milk protein
  • Triamcinolone, hydrocortisone, methylprednisolone – benzyl alcohol

References